Proposal of an obesity classification based on weight history: an official document by the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Society for the Study of Obesity and Metabolic Syndrome (ABESO)

ABSTRACT Obesity is a chronic disease associated with impaired physical and mental health. A widespread view in the treatment of obesity is that the goal is to normalize the individual's body mass index (BMI). However, a modest weight loss (usually above 5%) is already associated with clinical improvement, while weight losses of 10%-15% bring even further benefits, independent from the final BMI. The percentage of weight reduction is accepted as a treatment goal since a greater decrease in weight is frequently difficult to achieve due to metabolic adaptation along with environmental and lifestyle factors. In this document, the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Society for the Study of Obesity and Metabolic Syndrome (ABESO) propose a new obesity classification based on the maximum weight attained in life (MWAL). In this classification, individuals losing a specific proportion of weight are classified as having "reduced" or "controlled" obesity. This simple classification - which is not intended to replace others but to serve as an adjuvant tool - could help disseminate the concept of clinical benefits derived from modest weight loss, allowing individuals with obesity and their health care professionals to focus on strategies for weight maintenance instead of further weight reduction. In future studies, this proposed classification can also be an important tool to evaluate possible differences in therapeutic outcomes between individuals with similar BMIs but different weight trajectories.

Chronic non-communicable diseases and the economy / Las enfermedades no comunicables crónicas y la economía

There is no question that chronic non-communicable diseases (CNCDs) pose the single, greatest sustained threat to the stability of health systems worldwide. While undoubtedly the main dimension of the CNCDs challenge is in respect of the health and well-being of the population, it is becoming increasingly obvious that CNCDs are also posing a serious challenge to economies. Health system costs are increasing faster than national income in almost all nations and the main cause is the growing incidence of CNCDs and the diverse spill-over effects. The concern is that if this continues, there will come a time when the economic system will simply no longer be capable of coping with the burden of the CNCDs. In these circumstances the economist has two major concerns. The first is to understand and explain how CNCDs affect the functioning of the economic system. It is argued that while the analysis will necessarily begin on the qualitative level, for policy purposes it must also be taken to the quantitative level. The second major concern of the economist is to understand and explain how the working of the economy influences the incidence of CNCDs in particular countries. The author suggests that at a time when the prevention and management of CNCDs are high on the agenda of many nations, it is important to know whether the measures being taken to improve human development and economic well-being are themselves contributing to an increasing incidence of CNCDs particularly in small, vulnerable, open economies. In this regard, this paper briefly explains how CNCDs affect the economic system and presents some of the estimates of quantitative impact on the economy.

No hay duda de que las enfermedades no comunicables crónicas (ENCCs) representan la única y mayor amenaza sostenida para la estabilidad de los sistemas de salud a nivel mundial. Si bien no cabe duda de que la dimensión principal del desafío de las ENCCs se presenta con respecto a la salud y el bienestar de la población, se hace cada vez más obvio que las ENCCs representan también un serio reto para las economías. Los costos del sistema de salud están aumentando más rápidamente que el ingreso nacional en casi todas las naciones y la causa principal es la incidencia creciente de las ENCCs y los diversos efectos de desbordamiento. La preocupación es que si esto continúa, llegará el momento en que el sistema económico simplemente no podrá soportar más la carga de las ENCCs. Según el autor, en estas circunstancias el economista se enfrenta a dos problemas principales. El primero es entender y explicar cómo las ENCCs afectan el funcionando del sistema económico. En este punto, se aduce el argumento de que aunque el análisis tendrá necesariamente que comenzar en el nivel cualitativo, por razones de las políticas a seguir, tendrá que ser llevado también al nivel cuantitativo. El segundo problema principal del economista es entender y explicar cómo el funcionamiento de la economía influye en la incidencia de las ENCCs en países específicos. El autor sugiere que en un momento en que la prevención y el tratamiento de las ENCCs constituyen una prioridad en la agenda de muchos países, es importante saber si las medidas que se están tomando para mejorar el desarrollo humano y el bienestar económico, estén acaso contribuyendo ellas mismas a una creciente incidencia de las ENCCs, especialmente en las economías pequeñas, vulnerables, y abiertas. Al respecto, el autor explica brevemente cómo las ENCCs afectan el sistema económico, y presenta algunos estimados del impacto cuantitativo sobre la economía.

Estimating the cost of hospital services in a small island state: a case study of the Milton Cato Memorial Hospital in St Vincent and the Grenadines / Estimación del Costo de los Servicios Hospitalarios en un Pequeño Estado Insular Estudio de Caso del Milton Cato Memorial Hospital en San Vicente y las Granadinas

Cost estimates are derived for services provided at the Milton Cato Memorial Hospital (previously known as the Kingstown General Hospital) using the step-down accounting method Both total and average unit cost estimates are provided Among the findings of note is that the cost per patient per day spent on the Maternity Ward is 57.4 higher than for the Surgical Ward. Even with the 1995 increase in user fees, the levels of subsidization for inpatient services remains relatively high at 78-96 for public patients and 43-72 for private patients. Ancillary services werefoundto have lower levels of subsidization and in most cases the full costs were recovered from private patients. Laboratory services are not subsidized

Se deducen los costos estimados para los servicios que se brindan en el Milton Cato Memorial Hospital (previamente conocido como Kingstown General Hospital) usando el método de etapas en contabilidad. Se ofrecen los estimados del costo total y el costo promedio por unidad. Entre los resultados a resaltar se halla que el costo por paciente por día en la sala de maternidad es 57.4% más alto que en la sala de cirugía. Incluso con el aumento llevado a cabo en 1995 en relación con el pago de honorarios por parte del usuario, los niveles de subvención de los servicios a pacientes hospitalizados permanecen relativamente altos, llegando a ser de un 78%-96% para los pacientes públicos y 43% - 72% para los pacientes privados. Se halló que los servicios suplementarios presentaban niveles de subsidio más bajos, y que en la mayor parte de los casos se recuperaba la totalidad de los costos de los pacientes privados. Los servicios de laboratorio no se subvencionan.